I promised Markku an update on Neuromonics several months back so here it is.

My experience with Neuromonics

My hearing loss and tinnitus were a result of noise exposure due to my former employment. I was able to get the Neuromonics treatment because of a workers comp award. I was just about at the end of my rope at the time so I paid out of pocket (about $5000) and hoped that I would get reimbursed for the costs of the treatment. I was eventually reimbursed so the treatment cost me nothing. I am often asked “did it work?, was it worth it?, would you do it again”? Here is my reply.

Jan 2010
I started with the Neuromonics treatment. Used it daily, sometimes several times a day for many hours. Wore it everywhere, driving, sitting reading, doctors office, watching tv, exercising, etc. etc. etc. Went in for monthly evaluations and counseling.

Aug. 2010
I have been using the Neuromonics device for about 6 months now. I recently went to my audiologist for a recheck. My T levels were significantly down across the spectrum. I was retested for frequency, volume and perception. The volume was down by about 30%. The frequency has changed a little to a more comfortable "hiss". The big change was in my "perceived" level of impairment. I went from about 90% to about 20-30%. This is measured by a questionnaire filled out by the patient. It is a measure of the patients "perceived" level of discomfort in response to about 20 questions. I have had many ups and downs in the level of discomfort but there is a general downward trend over time. So...does Neuromonics work? I'm not sure. Maybe my T would have decreased had I done nothing. I have tried everything that seemed reasonable to me in search of relief so it's hard to say what worked and didn't work. In my opinion, yes (see my update below) it has helped me significantly and it is a reasonable tool in the arsenal against T. I am wearing it as I type this entry.

UpdateJan. 2012
I quit using the Neuromonics device around January 2011. I used it for about a year. I was quite desperate for some relief when I started using it. I think I now have a little distance and more objectivity regarding it’s effectiveness. A year ago I would have said that I thought it worked for me. Now I think I could have achieved the same results without it. Although it did provide some hope and temporary relief via masking and counseling, I could have gotten the same effect from a couple of simple masking tracks on my iPod and some counseling from a knowledgeable person and time. The audiologist who administered the treatment was helpful with his reassurance and coaching. The whole neuromonics tracking system gives the appearance of some real sciency stuff going on. Lots of graphs and charts and comparisons with other patients. For most of us tinnitus goes up and down and the Neuromnics system has a way of convincing you that those fluctuations are a result of the treatment and they should have a downward trend over time. I did have improvement over time and have had continued improvement after I quit using it. I attribute those improvements to several other things. Bottom line is I don’t think it worked for me in the way their marketing would suggest.

Thanks for posting this feedback on Neuromonics - it's interesting to get a longer-term perspective on this particular treatment.
I'm based in the UK and my understanding is that neuromonics isn't available here but that there is a similar device-system - acoustic neuromodulation reset - which works on similar principles and claims to achieve the same results through "stimulating the auditory pathway to promote neural plastic changes" rather than simple masking.

The neuromoulation device is similarly extremely expensive and also available only privately. I believe that a clinical trial of it is underway at Nottingham University, but that the results are not likely to be available until next year.

I'm sceptical about the claimed results for both these two systems, in particular that they can achieve more than standard sound therapy.

Newman and Sandridge (2012) report that sound therapy and counseling have achieved widespread acceptance among audiologists as the protocol of choice for managing tinnitus patients. However, due to the contemporary economic climate and realities, they report it is critical for clinicians to justify the value of their treatments, even though the “selection of a particular therapy option should not be isolated solely to economic factors….”

As such, they reported on 56 patients from the Tinnitus Management Clinic at the Cleveland Clinic with regard to comparing tinnitus treatments based on sound generators (SGs) and the neuromonics tinnitus treatment (NTT) device (the NTT uses a spectrally modified music stimulus). The tool they used to measure tinnitus was the tinnitus handicap inventory (THI). When comparing THI scores at baseline (pre-treatment) to THI scores six months post-treatment, both groups (SG and NTT) demonstrated a significant reduction in tinnitus for SG and NTTs. However, there were no differences in the SG or NTT treatment groups.

Newman and Sandridge conclude that both protocols (SG and NTT) yielded significant improvements with regard to quality of life (HRQoL)issues, based on the THI improvements, and they report that SG appears to be more cost efficient than NTT. Indeed, with specific regard to Newman and Sandridge, Jacobson (2012) notes “the cost per unit of improvement (treatment utility) on the THI (that has a scale from 1–100 points) measured in “quality-adjusted life years” was $604 per point for the sound generator treatment compared to $1,771 per point for the neuromonics treatment. The implication here is that equivalent gains might be obtained at a lesser cost to the patient.”

Change will not come if we wait for some other person or some other time. We are the ones we've been waiting for. We are the change that we seek.
— Barack Obama

That's a great study. Fear underlies a lot of tinnitus anxiety, and it is the main obstacle to habituation. Both Neuromonics and sound generators desensitize people to their tinnitus by introducing an external source of noise that the mind perceives as harmless. Both therapies take months--if not a year or more--to achieve habituation for most individuals. Just as it took your brain months to get "wired" to your tinnitus it equally takes as long to "unwire" it.

Most people would argue that Neuromonics is just a modern version of Tinnitus Retraining Therapy (TRT). Both utilize noise and counseling to facilitate habituation. TRT utilizes sound generators (SG) and Neuromonics employes an iPod with white noises. Finally, both embed a patient's own tinnitus sounds in their respective devices.

The few patient reviews I've read about Neuromonics, moreover, suggest it might be more helpful for hyperacusis than tinnitus. But the reviews I've encountered are from people who are dissatisfied with the therapy. Happy campers usually aren't utilizing the Internet to sing praises. Happy campers are on the Neuromonics site with their glowing testimonials!

Sound therapy or white noise in any form probably helps most people. It just takes time. For severely anxious people, however, sound therapy should be utilized along with counseling and perhaps medication. My own audiologist--whom I believe to be very honest--does recommend Neuromonics to her anxious patients. Of course, she's only been trained in Neuromonics--not TRT. I believe the counseling Neuromonics offers is less extensive than TRT. But they both are designed on the neurophysiological model of tinnitus. (Of course, that model was invented by Jastreboff, the founder of TRT.)

I don't know if this has been posted before, but here is an explanation of the neurophysiological approach to tinnitus, written by Jastreboff, et al.

I talked to a leading expert on T a few months back and I asked him if T would most likely improve anyway without a sound device and he told me yes. The sound may or may not change, but he brain will. I think using sound distracts you while adding in counseling does the real change, the change in your perception. That be said if using sound to help you achieve habilitation works for you then by all means do it.

I recently saw a tremendous augiologist we have here in Melbourne about my T, Dr Ross Dineen (he's had a few studies published on varying topics to do with tinnitus and hyperacusis). When I brought up these therapies, he was actually quite dismissive of devices like Neuromonics because of the lack of significant evidence available to prove their efficacy, especially for the ridiculous amount of money you have to put up just to try it out.

I've always been a bit iffy on many of these sound device therapies. I appreciate the effort and research put into the ideas behind such therapies, but it's ridiculous that these therapies always seem to require a special "sound device" that, coupled with the counselling, cost patients thousands of dollars. From my understanding, most of these devices are infact no different to any regular mp3 player available to anyone at a fraction of the price. It's a bit of a scam really, I would be more forgiving if we were still stuck in the 90's and if the technology wasn't available. But it seems they could achieve similar results if they were to offer the masking tracks themselves coupled with the counselling, without the propreitary sound device, but money talks I guess.

One thing that also sticks out to me when it comes to these therapies (TRT included) is that, from what I've read, most patients are told to expect an improvement over many months (8-12, I've even seen 2 years) but for me - most improvements you experience in that time period result from primarily from habituation. At least that's the opinion I've formed.

yonkapin -
You make some great points. I went from using maskers, finally to wearing hearing aids. When I first got T, the maskers sort of helped. Now that I look back, I think I could have easily used an IPod with white noise. The advantage of maskers is that you can wear them and talk to people without the need to take them out. They are small and discrete.

The idea of any sound therapy is to make the tinnitus less noticeable, so that a person stops dwelling so much on their tinnitus. "Habituation" is adjusting to a new reality, like moving into a house where it's always raining. Jastreboff and Hazell use maskers as a TRT tool, to provide some relief. A person needs relief time, to recoup and get happy. But they admit it would be great to have better methods to alleviate the stress of tinnitus.

We seem to fall into two camps here: Those in favor of sound therapy and those in favor of drug therapy. In my opinion, hearing aids are like sound therapy. Although hearing aids don't send sound to your ears, they compensate for the imbalance. For some people, hearing aids are the answer. For others, they don't help at all.

The problem that I have with drug therapy is, drugs are administered in a broad based fashion, effecting the whole brian. If there was a way to administer a drug to the specific location of the tinnitus, that would be the best approach. the US military is currently working on such an approach. As it stands now, when you pop a pill, it's like using a shotgun to kill a fly.

The problem that I have with drug therapy is, drugs are administered in a broad based fashion, effecting the whole brian. If there was a way to administer a drug to the specific location of the tinnitus, that would be the best approach. the US military is currently working on such an approach. As it stands now, when you pop a pill, it's like using a shotgun to kill a fly.

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Very true, I've had my own experiences with various pharms and have decided to stay away all together until there is something designed specifically for tinnitus. With most of the drugs I see mentioned, there are very significant side effects that many of us are willing to completely ignore in the hopes of some sort of temporary reduction in volume. The shotgun analogy is fantastic.

For me, and I think I'll make a thread about this soon, the best form of treatment for myself was finding a great doctor to work with. I wasted too much time with shoddy GPs, augiologists and very greedy ENT's. It took me a while but finding a great doctor (in this case an audiologist) who was able to address my concerns in great detail and discuss my ideas and worries about this condition made a very significant difference to my emotional reaction to my T. I think there's a big issue with patients not recieving the support they need when dealing with something so complicated and multi-layered.

the best form of treatment for myself was finding a great doctor to work with. I wasted too much time with shoddy GPs, augiologists and very greedy ENT's. It took me a while but finding a great doctor (in this case an audiologist) who was able to address my concerns in great detail and discuss my ideas and worries about this condition made a very significant difference to my emotional reaction to my T

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... shows how a single person, the right person, can make a huge difference. Maybe even more important is that it shows what a little genuine care and attention can do. Providing that care cost the caregiver no more time, effort, or money than the standard "tough it out - I don't really want to help, I don't really understand, and I don't really want to understand" attitude - and it presented no side effects to the patient. Its strange how doctors have not picked up on the idea that just a little care, attention, and true understanding can go a long way. That's been my biggest complaint about doctors since finding myself in their mercy the past few years: so little communication; so little effort at understanding the patient's complaints and fears; too dismissive. Why they think treating patients like dumb farm animals is good business, I'll never know.

That's been my biggest complaint about doctors since finding myself in their mercy the past few years: so little communication; so little effort at understanding the patient's complaints and fears; too dismissive. Why they think treating patients like dumb farm animals is good business, I'll never know.

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Well said, mick!

Why enter medicine in the first place? Of course, you should love science. But shouldn't you also want to help people? Clinical objectivity is not compromised by showing your humanity. Equally important, there are things doctors can do, but usually don't. Most don't give their patients steroids, for example, in an effort to reduce inflammation that will worsen any nerve damage. Finally, why not refer patients to other practitioners who can also help, like therapists, audiologists, etc.? You don't have be on your own! This should be a message the ATA conveys to ENT's. A paradigm shift. No more nihilism. A caring attitude.

Well, I finally had my long-awaited tinnitus evaluation with a clinical audiologist yesterday. I feel like I am moving more down the "acceptance-let's manage it" path now vs. the "denial-let's concentrate on what caused it" path. My anxiety/panic did kick in some, but much more under control than it was three weeks ago. My new guided meditation CDs sure do help!

Anyway: I tested "severe" on the TFI inventory (no surprise there). I do have a little hearing loss on high frequencies, which lead the audiologist to believe there may be some inner ear hair damage, but no loss near enough to require a hearing aid. The audiologist did mention some test results on tone matching/loudness that I am going to ask about here under another post later, as I don't quite understand them. Aud said she was happy to answer any follow up questions, and I was pleased with her professionalism and compassion. She did her initial TRT training under Dr. P years ago.

Anyway, I was offered two options beyond trying to do it myself with an MP3 player:
Neuromonics Oasis: $5,900 (ouch). Device is not returnable.
Widex Zen (even though I don't have a hearing problem): $3,200. Most of my investment can be recovered within 60 days if I am not satisfied.

These prices indeed are outrageous. But I do feel I would benefit, as the aud agreed, as I will feel I am doing something to help myself. I still am on very very low doses of alprazolam, which isn't ideal, but the aud said were low enough that it still would be effective. There was no high pressure to buy, though. The prices include rechecks and counseling sessions.

So: What are members experiences here with these devices? I have already read some of the many posts on here, and see the opinions are mixed. I agree the prices are absurd. But I am willing to pay it if it helps.

Re. the Widex: I worry that the "chimes" would make me nuts, as others here have reported. And I have to wear them all day, versus 2-4 hours for Neuromonics. And I don't need a hearing aid. I also have seen no research discussing Widex's success diminishing tinnitus perception in people without a hearing problem. But the Widex is more portable, less money.

Dang, sorry for the long post. Advice greatly appreciated. You guys rock.
LadyDi

Our @Steve H could come up with similar tones as Widex has for you and you could play them through a cheapo MP3 player using either headphones or earphones.

Regarding Neuromonics, if you read the rest of the posts in this thread, you should be able to form an opinion.

It's outrageously expensive, and if you find someone on the internet has seemingly benefited from it, there's a good chance they would have gotten naturally better anyway or by using any kind of sound enrichment.

In my opinion, the counseling sessions are probably the only thing worthwhile. But you should be able to get counseling for less money, without having to resort to either of these devices.

Basically, I don't think you will be getting your money's worth buying either device. The value just isn't there.

However, since you are able to return the Widex Zen within 60 days, you could try it and see how it works for you. One positive side to that device is that it's small. If you like the sounds it produces, and like how lightweight and inconspicuous it is, and have the money for it, then maybe it could be the right fit for you.

Change will not come if we wait for some other person or some other time. We are the ones we've been waiting for. We are the change that we seek.
— Barack Obama

Thanks Markku. I think just want to do SOMETHING that makes me feel like I am trying to help myself and Neuromonics felt like a good fit. But the price s inspiring me to do some serious research. No going to make any quick decision.

I agree with Markku that since you don't have much hearing loss, the cost is not worth it for either device. You can do as Markku suggested with an mp3 player or if you have a smart phone, there are many free apps which could help you with portable sound enrichment. I too once measured severe on the TFI and what worked for me was a combination of: counseling, some meds, meditation, gardening and finding any way to address my extreme anxiety while slowly working back to doing things I abandoned once I got T. I downloaded and used the Audible.com app on my phone to listen to audio books when taking walks, which was a great distraction. I downloaded apps like Relaxing Melodies for my iPad and phone to listen to day and night. But most of all, I believe "time" is your best ally. You need time for you to adjust, time for your body to adjust and time for your brain adjust. It is not quick, but it happens. The body and brain are amazing and do adapt to neuro changes. You are on the right track!

@LadyDi, As Markku says I can reproduce a very similar thing to the Widex zen, it really is a very simple random tone generator with a few sounds. If I had to put a realistic value on it I would say it should retail at no more than $100. Nothing you can't do with an Mp3 player and comfortable earphones. I use Airdrives, they sit on top of your ears so don't block any external sound. Sound isn't great but they're ideal for listening to masking sounds. But you really have to use whatever you find most comfortable to wear and listen to.

If you can tell me the frequency of your T and what sort of sounds you find soothing and pleasant I'll work some sounds up for you.

I'm not 100% what principle Neuromonics treatment works on, but if I find out I can replicate that too.

There is no path to happiness: happiness is the path - Siddhartha Gautama

Thank you so much Steve I would like to try it. So I need my T frequency? What would that number look like? I am using Sennheiser px 685i sports headphones... Very small and lightweight but sit on the outside of the ear canal without completely covering the ear.

I still may go the Neuromonics route. But I am holding off to hopefully go with a program at the University of Miami, so I then would be at a research institute. But it will take at least another two months.

In the meantime, my anxiety and panic is driving me crazy. Thanks for your suggestions Erik. It was helpful to know you suffered too.

Just been reading some info written by Neuromonics to 'train' audiologists.

From what I read it is simply a masking tone developed to the patients tinnitus profile. This is played back at a level to cover the T with music over the top. The music is created / designed / recorded to represent a full audio spectrum, up to 12,500Hz so that it stimulates a wide range of hearing.

The treatment also features a portion of counselling and adjusting to the tinnitus profile.

Basically it sounds to me like TRT with a little bit of extra. I (and several others on this forum) could replicate this treatment very easily. Nothing special. In my very humble opinion you are paying for the consultants and company directors' 2nd / 3rd homes / lifestyles.

This is a very interesting statement from one of their presentations that casts a huge shadow for me over any research I hear quoted by them:

In our third clinical trial, we conducted a survey looking specifically at patients who had reported a moderate or large benefit from the Neuromonics Oasis device (Davis, Paki, & Hanley, 2007). Of those patients, 97 percent were able to achieve relief from their tinnitus; 94 percent experienced an improved ability to fall asleep; 94 percent perceived a sense of control over their tinnitus; and 94 percent noted an improved ability to relax.

Em, yes. Very scientific. So, of the 100% of people who reported a significant benefit (this could be 10 out of 1000 for all I know) most of them had the listed benefits. I should hope they did. What concerns me is that the intended audience are audiologists.

The full text for those that want to read further, amongst others by them, can be found here:

Hey Steve
Sorry this conversation somehow got moved over to the masking thread, where I guess it will stay. Probably my fault as I may have forgotten exactly where we started talking. Anyway I posted my eval results there and am still looking for db SL.

I did find the training info interesting...it's pretty much what my audiologist said. But I must say, also found it helpful. Even though my aud was very supportive, she still has a time window for patient visits and much of this was rushed through. I take it that your main complaint about Neuromonics is that it's very overpriced for what patients, if they were knowledgable and motivated enough, could do on their own for far less. Think that's probably true. Also, that the success stats (94 percent and the like) are skewed which I think also is true. But I do think a lot of patients get success from this treatment and I remain interested. I just want to do it in university clinic setting which will take a while longer to get into.

If nothing more, I appreciate that Neuromonics understands this is as much a disorder of the brain as of the ears. The ENTs truly don't get that. Anyone who tells you "you'll learn to live with it" when you are having anxiety attacks should lose his/her license.

amazing that someone who is supposed to be a specialist on ear, nose and throat conditions is not capable of educating themselves on tinnitus and hyperacusis. I think they should undergo a yearly license control to make sure they are updated and capable of giving actual T/H treatment advice. As you say, it just isn't acceptable to brush people off with the all so familiar "deal with it" response. Imagen if a car mechanic said that to everyone that came in with a broken gear box? After 1 1/2 months of intense research within the world of T/H treatment I have already found a plethora of wrong claims from the ENT surgeon that diagnosed me.

Do you think I could treat my T&H on the basis of a hearing test that included all the frequencies? Let's say I did a test at an audiologist to map down the frequencies and based on that created the noise (pink, white whatever) to cater for those or that frequency? What if the tests show that my H is on more than one frequency? My hearing test did not include all the frequencies, I suspect that my H is caused by a hearing loss, like in the very high frequency area. I guess I will know sometime during this autumn. My "normal" hearing test result was ok.

@Per: I agree. I pretty much have had to put together my team dealing with the brain/automatic and limbic response of my T on my own. Sadly, have not found a lot of psychiatrists or psychologists with a lot of experience specifically with T but at least they have been helpful. ENTs basically say sorry, can't fix it, good luck.

Again, not that I am any expert. But my guess is your initial hearing test did not pick up all of your frequencies. If you read the Neuromonics provider training material Steve links to above, they mention that. The material suggests their trainees do a second test (the O something?) that apparently is more sensitive. Like you, my initial test with the ENT's office showed no real hearing loss. But my second test, done during the tinnitus eval that in part shows if I am a Neuromonics candidate, showed some loss at very high frequencies.

@LadyDi A lot of audiologists only have equipment which tests up to 8000Hz, so the extra test is probably using equipment that lets them go to higher frequencies. You may also be getting tested to see that you can pinpoint the frequency of your T as the neuromonics treatment simply creates a noise at the frequencies you hear and plays it back. Think of it as targeted masking.

I don't necessarily have an issue with the treatment, I do however question its efficacy when i look at their flimsy excuse for a clinical trial. And I do think that you can find your own masking tones, play them back on a music player with some music with a broad frequency range and book appointments with a therapist for far less. But of course. it's totally up the individual.

@Per Yes, if you can get the frequency and the range then you can treat the T in a similar way. The H is a bit different. I have beaten it away in the past (though it returned recently after the ANM trial) by facing it and convincing myself that the noise can't hurt me, I had white noise generators but I didn't feel that they were of a benefit to it. The best battle against it - for me anyway - was education. Understanding that the level and duration of the noises that cause you pain / discomfort won't damage your hearing or hurt you. It took me quite a while, and I still keep away from certain sounds, but it can be done.

There is no path to happiness: happiness is the path - Siddhartha Gautama

Hi All, I recently became aware of my tinnitus as a sudden onset one night upon going to bed, I have had it before many years ago. In my caes it may have been from taking Nurofen (ibuprofen) for two months for chronic pelvic pain syndrome that have been suffering with, (the tinnitus became noticable after I stopped taking the medication) which after specialist physio is on the improve. Even though its only been a few months its has been quite distressing, especially as the pitch was up in the range of 16kHz, which is very hard to mask. I have had the same weak, silly just get used to it, response from my GP. I took myself off to Melbourne Audiology and sat through the hearing test. My hearing is as expected for a 45 year old male, with slight loss in the upper end 16kHz. The audiologist showed me the very expensive neuromonics device, that was around the $5500 mark. She however indicated that there are iPhone/iPod apps available on the app store for free. The two I have been using are called mytinnitus and isuppress. I started with the isuppress matching the frequency with a white noise up around the 15-16kHz and just have it at a volume so as to mask my own tinnitus and would use it for up to 3 hours per day, after about a month things seem to be starting to change.

I then moved across and started using the mytinnitus app and by sliding the frequency bars around can match my tinnitus frequency almost exactly. I listen at night in the lead up to bed time and have found that the frequency is definately changing the actual high pitch squealing sound into a gentle tinkling sound. It appears to be breaking up the single tone squeal into pieces (hope that makes sense) So this is either habituation at work or there are definate plastic changes going on in the auditory cortex of my brain. I had been using Temazepam for nearly two months to sleep but have been weaning myself off this over a few weeks and now no longer need them to sleep, this is becuase the pitch has reduced and seem to be dissappearing into the background. Potentially being off the Nurofen and Temazepam is helping as both these drugs are known to be ototoxic and can/may cause tinnitus.

This has been my experience so far. I will post more as things change, I hope this info will be of some use.

Thanks for sharing. Sounds great to be able to sleep and get the T frequency changed to an "easier" or more manageable level. That's my hope for the future as well. I also did a lot of Ibuprofen with Codeine this spring cause of adhesive capsulities, but guess I'll never know the cause of my loud high pitched T because I tick more boxes.

I have general questions that apply to Neuromonics as well as other treatments involving a masking signal. When I listen to pure tones on my computer, I find that as I raise the frequency, I need to crank the volume higher and higher to be able to hear the signal. For very high frequencies (over 12 Khz), I can't hear anything.

(1) Is this normal that one needs increased volume to hear higher frequencies?
(2) Am I simply deaf to the higher frequencies; or could it be that my computer is unable to process these high frequency signals? Or, do I simply need to raise the volume even more?
(3) If my tinnitus is at a very high frequency, say above 12 Khz, is it safe to listen to a tone that for which I have to crank up the volume?

you have what most of us have is a ski slop noise related hearing loss - i can't hear anything up there either. personally, my own opinion, is to not crank it, i am trying the neuro modulation DIY and they say to play it quietly, my top tone in the sound MP3 is set at +5 which is safe, so i don't actually make the hearing loss worse.

you have what most of us have is a ski slop noise related hearing loss - i can't hear anything up there either. personally, my own opinion, is to not crank it, i am trying the neuro modulation DIY and they say to play it quietly, my top tone in the sound MP3 is set at +5 which is safe, so i don't actually make the hearing loss worse.

I can hear up to 13Khz, just. My kit is all capable of producing sounds at the higher frequencies and I can see a visual meter showing me they're playing. But I'm blank up there now. We all gradually lose the higher frequencies as we age, it's a natural process.

You should avoid too much level at those higher frequencies as it can be really damaging to your hearing. Your tinnitus may actually be a lower frequency but perceptually it seems higher.

There is no path to happiness: happiness is the path - Siddhartha Gautama